Fertility Concerns Affect Treatment Decisions in Younger Women with BreastCancer
Fertility concerns affect treatment decisions in a substantial proportion of young women with breast cancer; however, few women pursue available fertility preservation strategies, according to the results of a study published in the Journal of Clinical Oncology.
Women who confront a cancer diagnosis at a young age often must consider how cancer treatment will affect their ability to have children in the future. In the case of breast cancer, the likelihood of infertility is determined by multiple factors that include the patient’s age at the time of treatment and the specific type and length of treatment. In some cases, treatment with chemotherapy may result in permanent or temporary infertility. When treatment for breast cancer may result in infertility, it is important to inform patients about this possibility and their options for preserving their fertility.
As part of an ongoing prospective multicenter cohort study (Helping Ourselves, Helping Others: The Young Women’s Breast Cancer Study), researchers surveyed women aged 40 or younger with newly diagnosed early-stage breast cancer. The baseline survey included sociodemographic, medical, and treatment data as well as a modified Fertility Issues Survey, including fertility concern and preservation items.(1)
The median age among the first 620 eligible respondents included in this analysis was 37. Approximately one-third of the women expressed a desire to have children in the future. Sixty-eight percent of women reported discussing fertility issues with their physicians prior to starting treatment and 51 percent were concerned about becoming infertile after treatment.
A total of 26 percent of women reported that fertility concerns affected their treatment decisions. As a result of fertility concerns, 1 percent chose not to receive chemotherapy, 2 percent chose one chemotherapy regimen over another, 1 percent considered not receiving endocrine therapy, 3 percent decided not to receive endocrine therapy, 11 percent considered receiving endocrine therapy for less than 5 years, and 1 percent chose to have mastectomy.
Ten percent of women used fertility preservation strategies, including embryocryopreservation, oocyte cryopreservation, and gonadotropin-releasing hormone use.
Greater concern about fertility was associated with younger age, nonwhite race, not having children, and receipt of chemotherapy.
The researchers concluded that many young women with newly diagnosed breast cancer have fertility concerns. These fertility concerns sometimes affect treatment decisions, but only a small percentage of women pursue available fertility preservation strategies.
Pregnancy After Breast Cancer is Safe
A study of young women found that pregnancy after a diagnosis of estrogen receptor-positive breast cancer does not appear to increase the risk of cancer recurrence. These results were presented at the eighth European Breast Cancer Conference.Breast cancer is the most common type of cancer among women of childbearing age. For women who develop breast cancer before completing their families, many questions arise about fertility preservation and the safety of a subsequent pregnancy. In the case of estrogen receptor-positive breast cancer, there has been some uncertainty about whether the hormonal changes of pregnancy could increase the risk of cancer recurrence.To explore whether pregnancy affects risk of breast cancer recurrence, researchers from several countries conducted a study among 333 women who had become pregnant after a diagnosis of breast cancer, and 874 similar women who did not become pregnant.The women aged in range from 21 to 48 (average age was 34).
- Recurrence risk was similar in the women who did and did not become pregnant. This was true for women with estrogen receptor-positive breast cancer and for women with estrogen receptor-negative breast cancer.
- In the subset of women who became pregnant soon after their breast cancer diagnosis (within two years), risk of recurrence was actually somewhat lower than in the women who did not become pregnant. The researchers recommend caution in interpreting this result, noting “pregnancy within two years of diagnosis should be regarded as safe, and not as protective.”
- Miscarriage, abortion, and breastfeeding did not appear to affect breast cancer outcome.
Although this study does not provide definitive proof of the safety of pregnancy after breast cancer, these results should be reassuring to women who wish to become pregnant after a breast cancer diagnosis.Because some types of cancer treatment can affect a woman’s fertility, women who are interested in becoming pregnant should discuss the issue of fertility preservation with their physician before cancer treatment begins. (2)
- Ruddy KJ, Gelber SI, Tamimi RM, et al: Prospective study of fertility concerns and preservation strategies in young women with breast cancer. Journal of Clinical Oncology. Published early online February 24, 2014. doi: 10.1200/JCO.2013.52.8877
- Azim Jr H, Kroman N, Ameye L et al. Pregnancy following estrogen receptor-positive breast cancer is safe – results from a large multi-center case-control study. Paper presented at: eighth European Breast Cancer Conference (EBCC8); March 21-24, 2012; Vienna,Austria. Abstract 21.